RESUMEN
The American Academy of Psychiatry and the Law (AAPL) recently published guidelines for forensic assessment intended for psychiatrists and other clinicians working in medicolegal roles, or performing evaluations and offering opinions in relation to legal or regulatory matters. Although these guidelines do not establish a singular standard for forensic evaluation, they are intended to inform practice. Although nuances pertaining to any given case and the pertinent medicolegal issues involved will require professional judgment as to how best to conduct any particular evaluation, the guidelines do offer many helpful tenets and guiding principles that are broadly applicable. Psychiatrists and other clinicians performing forensic evaluations need to be aware of these guidelines and should strive to incorporate them as appropriate. In this column we offer a brief synopsis of the approach to the forensic psychiatric assessment based upon the AAPL Practice Guideline for the Forensic Assessment.
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Testimonio de Experto , Psiquiatría Forense/normas , Ética Médica , Testimonio de Experto/legislación & jurisprudencia , Humanos , Trastornos Mentales/diagnósticoRESUMEN
OBJECTIVE: Readmission rates have been proposed as a possible quality metric for inpatient psychiatry. Little is known about predicting readmissions and identifying modifiable factors that may reduce early readmissions in these settings. METHODS: We reviewed 693 medical records from our adult inpatient psychiatric unit to identify factors associated with patients' readmission within 90 days of discharge. RESULTS: After adjusting for all variables, and including interactions between identified factors, we found several demographic features predicting readmission, including male gender with suicidal ideation on admission (odds ratio [OR] = 13.2; 95% confidence interval [CI], 3.4-51.9), a diagnosis of a psychotic disorder with a prior medical admission (OR = 5.7; 95% CI, 1.7-20.6), and suicidal ideation with comorbid personality disorder (OR = 5.3; 95% CI, 1.4-20.6). Demographic features decreasing the odds of readmission included being non-white with homeless living situation (OR = 0.18; 95% CI, 0.04-0.82), medication changes made within 48 hours of discharge (OR = 0.44; 95% CI, 0.23-0.84), and the number of medications dispensed without documented follow-up plan or appointment (OR = 0.88; 95% CI, 0.81-0.96). CONCLUSION: Future prospective studies utilizing qualitative and quantitative methods are required to more precisely define a wider array of metrics. Improved identification of demographic features associated with early readmissions may suggest areas to target as we seek to the quality of inpatient psychiatric care.
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Trastornos Mentales/terapia , Readmisión del Paciente/estadística & datos numéricos , Servicio de Psiquiatría en Hospital/organización & administración , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Adulto , Comorbilidad , Continuidad de la Atención al Paciente/organización & administración , Femenino , Personas con Mala Vivienda , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Calidad de la Atención de Salud , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Ideación SuicidaRESUMEN
Only nine previous cases of self- or auto-cannibalism (autosarcophagy) have previously been reported in the literature. Here, we report a 29-year-old man with psychosis and a history of polysubstance use who presented after his second attempt to self-cannibalize. This case raises questions about the underlying causes and dynamics of self-cannibalism in psychiatric illness and its relation to other types of self-harm behavior.
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Canibalismo/psicología , Trastornos Psicóticos/fisiopatología , Conducta Autodestructiva/fisiopatología , Adulto , Síntomas Afectivos/fisiopatología , Personas con Mala Vivienda/psicología , Humanos , Masculino , Trastornos Paranoides/fisiopatología , Aislamiento SocialAsunto(s)
Chinches , Infestaciones Ectoparasitarias/psicología , Miedo , Trastornos Mentales/epidemiología , Adulto , Anciano , Animales , Enfermedad Crónica , Costo de Enfermedad , Susceptibilidad a Enfermedades , Infestaciones Ectoparasitarias/epidemiología , Epidemias , Femenino , Hospitalización , Hospitales Psiquiátricos , Humanos , Control de Insectos/organización & administración , Control de Insectos/normas , Masculino , Trastornos Mentales/etiología , Trastornos Mentales/psicología , Persona de Mediana Edad , Cooperación del Paciente , Calidad de Vida , Factores de Riesgo , Aislamiento Social , Estigma Social , Ideación Suicida , Intento de Suicidio/psicología , Salud Urbana , Adulto JovenRESUMEN
A prior report described the presentation of cocaine-induced trichotillomania, which resolved with the cessation of cocaine use. Here the authors describe the case of stimulant-induced trichotillomania that resolved with the discontinuation of stimulants and initiation of olanzapine. To the authors' knowledge this is the first reported adult case of stimulant-induced trichotillomania. The case is of a patient with a previous diagnosis of attention deficit hyperactivity disorder whose symptoms of trichotillomania coincide with abuse of amphetamine and with the resolution of symptoms in the absence of amphetamine use. Given the increase in exposure of prescription amphetamines among adults, further study into the association between stimulants and adverse events such as trichotillomania is needed.
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Anfetamina/efectos adversos , Estimulantes del Sistema Nervioso Central/efectos adversos , Tricotilomanía/inducido químicamente , Adulto , Humanos , MasculinoRESUMEN
OBJECTIVES: To review the clinical features and pathophysiologic implications of remitting seronegative symmetrical synovitis with pitting edema (RS(3)PE) presenting in a unilateral manner. METHODS: We identified and characterized an index case of RS(3)PE presenting in a unilateral pattern. We subsequently performed a systematic literature search to identify other reports of patients with unilateral RS(3)PE. RESULTS: The index case was a 76-year-old male with a prior history of right hemiparesis owing to a cerebrovascular accident 25 years prior, who developed a classic picture of RS(3)PE involving hand (metacarpophalageal and wrist joint) arthritis and dorsal pitting edema, accompanied by an elevated erythrocyte sedimentation rate, but only in the nonhemiparetic hand. The condition responded rapidly to low-dose prednisone. Our literature search identified 5 other cases of unilateral RS(3)PE, including 2 presented only in the Italian or German literature. Of the 5 cases, 2 were in patients with preexisting neurologic disease, in which the neurologically affected side was spared. One additional case initially presented as unilateral disease but rapidly progressed to bilaterality. Two cases presented in a fully unilateral manner despite no reported neurologic abnormalities on the unaffected sides. CONCLUSIONS: While RS(3)PE is almost always a symmetric disease of the upper extremities, it may rarely present in a unilateral fashion. The apparent ability of neuropathic changes to protect against the expression of RS(3)PE in an extremity suggests a role for neural and possibly other local factors in the genesis/modulation of the onset or maintenance of RS(3)PE.